Background: Optimal infant and young child feeding during the first two years of life is essential to optimum child development and health. While the link between feeding practices and child health outcomes is well documented, little is known about the determinants of these feeding practices in Indonesia. The purpose of this study was to better understand factors associated with appropriate child feeding among Indonesian children 6–23 months of age. Methods: Interviewers conducted interviews with 1498 mothers of children 6–23 months of age to identify practices. Measures of feeding practices included dietary diversity, meal frequency, and minimum acceptable diet. Multivariate logistic regression was used to identify factors associated with dietary diversity and separately with meal frequency. Results: After adjusting for covariates, increased maternal education was associated with improved dietary diversity. Age of child [OR=1.11], knowledge of stunting [OR=1.80], and having ever received nutrition information [OR=1.89] were also associated with greater dietary diversity. Wealth [OR=0.86] and age of child [OR=0.92] were inversely associated with meal frequency. Maternal education, age of child, being a male child, knowledge of stunting, and having received nutrition information increased the odds of the child consuming a minimum acceptable diet. Conclusion: Increasing maternal education, knowledge of stunting, and knowledge of nutrition may improve dietary diversity while poverty alleviation has the potential to improve minimum meal frequency. These findings corroborate similar studies and confirm the importance of government efforts that help girls stay in school, improve families' understanding of nutrition, and reduce poverty.Background: Optimal infant and young child feeding during the first two years of life is essential to optimum child development and health. While the link between feeding practices and child health outcomes is well documented, little is known about the determinants of these feeding ...
In: Wissenschaftsethik und Technikfolgenbeurteilung, Schriftenreihe der Europäischen Akademie zur Erforschung von Folgen wissenschaftlich-technischer Entwicklungen Bad Neuenahr-Ahrweiler GmbH 23
In: Ethics of Science and Technology Assessment 23
The ever-increasing release of harmful agents due to human activities have led in some areas of the world to heavy pollution. In order to protect human health and the environment, environmental standards that shall limit the release and the concentration of those toxic agents in the environment and hence the exposure to it have to be established. The related assessment and decision-making procedures have to be based on solid scientific data about the effects and mechanisms of these agents as well as on ethical, social and economic aspects. For risk evaluation, the knowledge of the dose response curve is an essential prerequisite. Dose responses without a threshold dose are most critical in this connection. Such dose responses are assumed for mutagenic and carcinogenic effects, which, therefore, dominate also the discussion in this book. In the environmentally important low dose range, risk estimation can only be achieved by extrapolation from higher doses with measurable effects. The extrapolation is accompanied with uncertainties which makes risk evaluation as well as risk communication frequently problematic. In order to ensure rational efficient and fair decisions beyond a sound scientific assessment the dialogue between disciplines, with the affected people and with the general public is necessary. In this book, the whole range of relevant and essential aspects of risk evaluation and standard setting is addressed. Starting with the ethical foundations, the sound analysis of recent scientific findings sets the frame for further reflections by theory of cognition, psychosocial sciences, and jurisprudence. The authors end up with concluding recommendations for coping with the recent problems of standard setting in the field of environmentally relevant low doses. The book is designed to a readership of scientists, legislators, administrators, and the interested public
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BACKGROUND: There is uncertainty about the chemotherapy sensitivity of some oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers. Multiparameter assays that measure the expression of several tumour genes simultaneously have been developed to guide the use of adjuvant chemotherapy for this breast cancer subtype. The assays provide prognostic information and have been claimed to predict chemotherapy sensitivity. There is a dearth of prospective validation studies. The Optimal Personalised Treatment of early breast cancer usIng Multiparameter Analysis preliminary study (OPTIMA prelim) is the feasibility phase of a randomised controlled trial (RCT) designed to validate the use of multiparameter assay directed chemotherapy decisions in the NHS. OBJECTIVES: OPTIMA prelim was designed to establish the acceptability to patients and clinicians of randomisation to test-driven treatment assignment compared with usual care and to select an assay for study in the main RCT. DESIGN: Partially blinded RCT with adaptive design. SETTING: Thirty-five UK hospitals. PARTICIPANTS: Patients aged >/= 40 years with surgically treated ER-positive HER2-negative primary breast cancer and with 1-9 involved axillary nodes, or, if node negative, a tumour at least 30 mm in diameter. INTERVENTIONS: Randomisation between two treatment options. Option 1 was standard care consisting of chemotherapy followed by endocrine therapy. In option 2, an Oncotype DX((R)) test (Genomic Health Inc., Redwood City, CA, USA) performed on the resected tumour was used to assign patients either to standard care [if 'recurrence score' (RS) was > 25] or to endocrine therapy alone (if RS was = 25). Patients allocated chemotherapy were blind to their randomisation. MAIN OUTCOME MEASURES: The pre-specified success criteria were recruitment of 300 patients in no longer than 2 years and, for the final 150 patients, (1) an acceptance rate of at least 40%; (2) recruitment taking no longer than 6 months; and (3) chemotherapy starting within 6 weeks of consent in at least 85% of patients. RESULTS: Between September 2012 and 3 June 2014, 350 patients consented to join OPTIMA prelim and 313 were randomised; the final 150 patients were recruited in 6 months, of whom 92% assigned chemotherapy started treatment within 6 weeks. The acceptance rate for the 750 patients invited to participate was 47%. Twelve out of the 325 patients with data (3.7%, 95% confidence interval 1.7% to 5.8%) were deemed ineligible on central review of receptor status. Interviews with researchers and recordings of potential participant consultations made as part of the integral qualitative recruitment study provided insights into recruitment barriers and led to interventions designed to improve recruitment. Patient information was changed as the result of feedback from three patient focus groups. Additional multiparameter analysis was performed on 302 tumour samples. Although Oncotype DX, MammaPrint((R))/BluePrint((R)) (Agendia Inc., Irvine, CA, USA), Prosigna((R)) (NanoString Technologies Inc., Seattle, WA, USA), IHC4, IHC4 automated quantitative immunofluorescence (AQUA((R))) [NexCourse BreastTM (Genoptix Inc. Carlsbad, CA, USA)] and MammaTyper((R)) (BioNTech Diagnostics GmbH, Mainz, Germany) categorised comparable numbers of tumours into low- or high-risk groups and/or equivalent molecular subtypes, there was only moderate agreement between tests at an individual tumour level (kappa ranges 0.33-0.60 and 0.39-0.55 for tests providing risks and subtypes, respectively). Health economics modelling showed the value of information to the NHS from further research into multiparameter testing is high irrespective of the test evaluated. Prosigna is currently the highest priority for further study. CONCLUSIONS: OPTIMA prelim has achieved its aims of demonstrating that a large UK clinical trial of multiparameter assay-based selection of chemotherapy in hormone-sensitive early breast cancer is feasible. The economic analysis shows that a trial would be economically worthwhile for the NHS. Based on the outcome of the OPTIMA prelim, a large-scale RCT to evaluate the clinical effectiveness and cost-effectiveness of multiparameter assay-directed chemotherapy decisions in hormone-sensitive HER2-negative early breast would be appropriate to take place in the NHS. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42400492. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 10. See the NIHR Journals Library website for further project information. The Government of Ontario funded research at the Ontario Institute for Cancer Research. Robert C Stein received additional support from the NIHR University College London Hospitals Biomedical Research Centre.
This white paper provides a concise guide to key technology options for grid scale energy storage, with the aim of informing stakeholders in industry, government and the funding agencies of the opportunities and need for underpinning research into both current and emerging technologies for grid scale storage applications. The paper has been produced in recognition of both the need for cost effective, durable and safe grid scale energy storage solutions (across a wide range of power and energy levels) to support future low carbon energy systems and the need for underpinning research into new ideas and concepts to support the development and subsequent deployment of both emerging and new energy storage options.
The fields of human genetics and genomics have generated considerable knowledge about the mechanistic basis of many diseases. Genomic approaches to diagnosis, prognostication, prevention and treatment - genomic-driven precision medicine (GDPM) - may help optimize medical practice. Here, we provide a comprehensive review of GDPM of complex diseases across major medical specialties. We focus on technological readiness: how rapidly a test can be implemented into health care. Although these areas of medicine are diverse, key similarities exist across almost all areas. Many medical areas have, within their standards of care, at least one GDPM test for a genetic variant of strong effect that aids the identification/diagnosis of a more homogeneous subset within a larger disease group or identifies a subset with different therapeutic requirements. However, for almost all complex diseases, the majority of patients do not carry established single-gene mutations with large effects. Thus, research is underway that seeks to determine the polygenic basis of many complex diseases. Nevertheless, most complex diseases are caused by the interplay of genetic, behavioural and environmental risk factors, which will likely necessitate models for prediction and diagnosis that incorporate genetic and non-genetic data. ; Funding Agencies|SciLifeLab; Swedish Research Council (Vetenskapsradet)Swedish Research Council [D0886501]; US National Institute of Mental HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Mental Health (NIMH) [MH077139, MH1095320]; European UnionEuropean Commission [610307, 733161, 825843]; Swedish Cancer SocietySwedish Cancer Society; Swedish Research CouncilSwedish Research CouncilEuropean Commission [2018-02837, 2014-03352, 2009-1039, 2018-03307]; Knut and Alice Wallenberg FoundationKnut & Alice Wallenberg Foundation; Karolinska Institutet, Karolinska University HospitalKarolinska Institutet; Radiumhemmets Forskningsfonder; European Research CouncilEuropean Research Council (ERC)European Commission [CoG-2015_681742_NASCENT]; Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation [20160872]; Swedish Foundation for Strategic Research (IRC Center); Novo Nordisk FoundationNovo Nordisk FoundationNovocure Limited; ALF; Strategic Research Area Epidemiology at Karolinska Institutet; Swedish Rheumatism Association; Vth 80-year Foundation; Swedish Society of Medicine; Clinical Research Support (Avtal om Lakarutbildning och Forskning); Swedish government; county councils; ALF-agreement; Swedish Foundation for Strategic ResearchSwedish Foundation for Strategic Research [15-0067]; IMI2 Joint Undertaking [115974]; European Federation of Pharmaceutical Industries and Associations with JDRF; H2020 Program ERA PerMed JTC 2018 Call (VR) [2018-05619]
Tumor lymphocyte infiltration has been associated with clinical response to chemotherapy in estrogen receptor (ER) negative breast cancer. To identify variants in immunosuppressive pathway genes associated with prognosis after adjuvant chemotherapy for ER-negative patients, we studied invasive breast cancer patients of European ancestry with stage I-III disease, including 9,334 ER-positive patients (3,151 treated with chemotherapy) and 2,334 ER-negative patients (1,499 treated with chemotherapy). ; Funding for the iCOGS infrastructure came from: the European Community's Seventh Framework Programme under grant agreement number 223175 (HEALTH-F2-2009-223175) (COGS), Cancer Research UK (C1287/A10118, C1287/A10710, C12292/A11174, C1281/A12014, C5047/A8384, C5047/A15007, C5047/A10692), the National Institutes of Health (CA128978) and Post-Cancer GWAS initiative (1U19 CA148537, 1U19 CA148065 and 1U19 CA148112 - the GAME-ON initiative), the Department of Defence (W81XWH-10-1-0341), the Canadian Institutes of Health Research (CIHR) for the CIHR Team in Familial Risks of Breast Cancer, Komen Foundation for the Cure, the Breast Cancer Research Foundation, and the Ovarian Cancer Research Fund. The BCAC is funded by CR-UK (C1287/A10118 and C1287/A12014). Meetings of the BCAC have been funded by the European Union COST program (BM0606). The ABCS study was supported by the Dutch Cancer Society (grants NKI 2007-3839; 2009 4363); BBMRI-NL, which is a Research Infrastructure financed by the Dutch government (NWO 184.021.007); and the Dutch National Genomics Initiative. The work of the BBCC study was partly funded by ELAN-Fond of the University Hospital of Erlangen. The HEBCS study was financially supported by the Helsinki University Central Hospital Research Fund, Academy of Finland (266528), the Finnish Cancer Society, The Nordic Cancer Union and the Sigrid Juselius Foundation. Financial support for KARBAC study was provided through the regional agreement on medical training and clinical research (ALF) between Stockholm County ...
During an intensive Hubble Space Telescope (HST) Cosmic Origins Spectrograph (COS) UV monitoring campaign of the Seyfert 1 galaxy NGC 5548 performed from 2014 February to July, the normally highly correlated far-UV continuum and broad emission-line variations decorrelated for ∼ 60–70 days, starting ∼ 75 days after the first HST/COS observation. Following this anomalous state, the flux and variability of the broad emission lines returned to a more normal state. This transient behavior, characterised by significant deficits in flux and equivalent width of the strong broad UV emission lines, is the first of its kind to be unambiguously identified in an active galactic nucleus reverberation mapping campaign. The largest corresponding emission-line flux deficits occurred for the high-ionization collisionally excited lines, C iv and Si iv(+O iv]), and also He ii(+O iii]), while the anomaly in Lyα was substantially smaller. This pattern of behavior indicates a depletion in the flux of photons with Eph > 54 eV, relative to those near 13.6 eV. We suggest two plausible mechanisms for the observed behavior: (i) temporary obscuration of the ionizing continuum incident upon BLR clouds by a moving veil of material lying between the inner accretion disk and inner BLR, perhaps resulting from an episodic ejection of material from the disk, or (ii) a temporary change in the intrinsic ionizing continuum spectral energy distribution resulting in a deficit of ionizing photons with energies > 54 eV, possibly due to a transient restructuring of the Comptonizing atmosphere above the disk. Current evidence appears to favor the latter explanation ; Support for HST program number GO-13330 was provided by NASA through a grant from the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555. M.M.F., G.D.R., B.M.P., C.J.G., and R.W.P. are grateful for the support of the National Science Foundation (NSF) through grant AST-1008882 to The Ohio State University. A.J.B. and L.P. have been supported by NSF grant AST-1412693. A.V.F. and W.-K.Z. are grateful for fi- nancial assistance from NSF grant AST-1211916, the TABASGO Foundation, and the Christopher R. Redlich Fund. M.C. Bentz gratefully acknowledges support through NSF CAREER grant AST-1253702 to Georgia State University. M.C. Bottorff acknowledges HHMI for support through an undergraduate science education grant to Southwestern University. K.D.D. is supported by an NSF Fellowship awarded under grant AST- 1302093. R.E. gratefully acknowledges support from NASA under awards NNX13AC26G, NNX13AC63G, and NNX13AE99G. J.M.G. gratefully acknowledges support from NASA under award NNH13CH61C. P.B.H. is supported by NSERC. K.D.H. acknowledges support from the UK Science and Technology Facilities Council through grant ST/J001651/1. M.I. acknowledges support from the Creative Initiative program, No. 2008- 0060544, of the National Research Foundation of Korea (NRFK) funded by the Korean government (MSIP). M.D.J. acknowledges NSF grant AST0618209. SRON is financially supported by NWO, the Netherlands Organization for Scientific Research. B.C.K. is partially supported by the UC Center for Galaxy Evolution. C.S.K. acknowledges the support of NSF grant AST-1009756. D.C.L. acknowledges support from NSF grants AST- 1009571 and AST-1210311. P.L. acknowledges support from Fondecyt grant #1120328. A.P. acknowledges support from an NSF graduate fellowship and a UCSB Dean's Fellowship. J.S.S. acknowledges CNPq, National Council for Scientific and Technological Development (Brazil) for partial support and The Ohio State University for warm hospitality. T.T. has been supported by NSF grant AST-1412315. T.T. and B.C.K. acknowledge support from the Packard Foundation in the form of a Packard Research Fellowship to T.T; also, T.T. thanks the American Academy in Rome and the Observatory of Monteporzio Catone for kind hospitality. The Dark Cosmology Centre is funded by the Danish National Research Foundation. M.V. gratefully acknowledges support from the Danish Council for Independent Research via grant no. DFF 4002-00275. J.-H.W. acknowledges support by the National Research Foundation of Korea (NRF) grant funded by the Korean government (No. 2010-0027910). This research has made use of the NASA/IPAC Extragalactic Database (NED), which is operated by the Jet Propulsion Laboratory, California Institute of Technology, under contract with NASA. ; Peer-reviewed ; Publisher version